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Why is this important?

Pinpointing the source of your pain helps narrow down the cause of concern and location within the spine. These locations are cervical, thoracic, and lumbar regions. Each are treated differently.

How severe is your pain? *

Indicate the intensity of your pain on a scale of 1 to 10

1

2

3

4

5

6

7

8

9

10

* indicates a required field

Why is this important?

The Pain Scale has been used for decades in medicine because it is very effective in determining a subjective experience. Rating your pain on a 1-10 scale helps determine degree and urgency. A rating of ‘1’ is minimal pain while ‘10’ is the worst pain you have ever experienced.

How long have you experienced this pain?

less than 6 weeks

more than 6 weeks

Why is this important?

Pain is generally labeled by the medical community as either acute or chronic. Pain that is new or sudden and most times resolves within a short recovery time is considered ‘acute’. ‘Chronic’ pain is an ongoing pain that is persistent or recurring. Chronic pain can be present over several weeks, months, or even years.

Does this pain travel down into your arms

Yes

No

Why is this important?

Radiating pain can be related to an injury or condition occurring at a site of origin that is affecting a distal area such as the arms or legs. Even though the pain is felt in the extremity, the origin may a condition occurring at the nerve's root within the spine.

Which arm does the pain travel down into?

Left

Right

Both

Why is this important?

With back conditions, pain or symptoms described on a certain side indicates that impinged nerves or injury is occurring more on one side of a vertebrae than the other and gives the doctor an indication as to where to look for the problem.

Does the pain travel down all the way to your fingers?

Yes

No

Why is this important?

Length of nerve involvement may indicate the severity of impingement. Pain, tingling or numbness traveling the full length of the arm is receiving more nerve pressure than symptoms that may be only involve the upper arm.

Do you experience difficulty using your hands?

Yes

No

Why is this important?

Neurological deficits should not be ignored and warrants an exam by a doctor. Not only can this be a symptoms of a spine problem but it can also mean other serious problems within the circulatory or neurological systems.

Does pain travel down into your legs?

Yes

No

Why is this important?

Radiating pain can be related to an injury or condition occurring at a site of origin that is affecting a distal area such as the arms or legs. Even though it is felt in the extremity, the origin may a condition occurring at the nerve's root within the spine.

Which leg does the pain travel down into?

Left

Right

Both

Why is this important?

With back conditions, pain or symptoms described on a certain side indicates that impinged nerves or injury is occurring more on one side of a vertebrae than the other. This gives the doctor an indication as to where to look for the problem.

Does the pain travel all the way down to your toes?

Yes

No

Why is this important?

Length of nerve involvement may indicate the severity of impingement. Pain, tingling or numbness traveling the full length of the leg is receiving more nerve pressure than symptoms that were only felt in the buttock or thigh area.

Do your legs tire/hurt if you walk?

Yes

No

Why is this important?

Legs that tire or hurt with walking can be the symptoms of a variety of problems. Sometimes pain or weakness with walking can be either a neurological or a circulation problem. Both should be followed up with a physician’s examination.

Is the pain worse when you are:

Please Select the Option That Best Describes Your Pain While Performing the Following Activities

Sitting Down

Better

Worse

No Change

Standing Up

Better

Worse

No Change

Driving

Better

Worse

No Change

Lying Down

Better

Worse

No Change

Why is this important?

How you experience pain or gain relief helps your specialist determine cause. For example, pain with prolonged sitting may be a cervical issue whereas pain with prolonged standing may be a lumber issue.

What treatments, if any, have you received for this pain?

Check the box on the treatments below, or check "None"

Physical Therapy

Chiropractic Care

Injections / Pain Blocks

Surgery

None

Why is this important?

The history of your back exams and treatments helps in gathering information regarding your particular back problem. Having this information available for your doctor will often expedite optimal treatment options.

How did your Physical Therapy affect your condition and its symptoms?

Why is this important?

Knowing what helped or did not help gives spine professionals a starting point with creating your unique treatment regimen. Please describe what kind of result you experienced if you have ever had physical therapy.

How did your Chiropractic Care affect your condition and its symptoms?

Why is this important?

Knowing what helped or did not help gives spine professionals a starting point with creating your unique treatment regimen. Please describe what kind of result you experienced if you have ever had chiropractic care.

How did your Injection affect your condition and its symptoms?

Why is this important?

Knowing what helped or did not help gives spine professionals a starting point with creating your unique treatment regimen. Please describe what kind of result you experienced if you have ever any spine injections.

How did your Surgery affect your condition and its symptoms?

Why is this important?

Knowing if your surgery was effective or not helps gives spine professionals a starting point with creating your unique treatment regimen. Please describe what kind of result you experienced with any previous back surgeries.

Congratulations, Your Results Are Ready

To get your results, please fill in the few details below. Your information is private.

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Have questions?

Feel free to contact us by phone: 844-297-7463; or by email: info@cloud9spine.com.

Frequently Asked Questions

What is Cloud 9 Spine?

For nearly a decade, the experts behind Cloud 9 Spine have helped tens of thousands of individuals suffering from spinal conditions find the treatment they need to help get them back to living a pain free life.

How Does the Tool Work?

The evaluation tool gathers just the right amount of information on your pain, it's history, your background, and other factors to calculate a likley source of your pain as well as effective treatment options that may be available to you.

Who does Cloud 9 Spine help?

Cloud 9 Spine is here to help ensure patients see the right specialist suited to treat them just as it is committed to match spine specialists with qualifying patients.

What if I’m not happy with the doctor you suggest?

It’s important to us that we help our clients every step of the way. We do not simply pass you off to a specialist and walk away. We promise to be involved in the entire process, making sure you receive the highest level of care that we believe every person deserves.

How do you make sure the specialist is located near me?

We only provide services to patients that we can offer a specialist to that is near their area. We will review with your location with you before moving forward with any appointment scheduling.

What is the Cloud 9 Spine Pain Evaluation Tool?

This online smart-tool was developed with the help of our board certified orthopedic specialists to best determine your pain's cause, severity, and local treatment options.

What about privacy?

We keep all your information private and none of the information is shared with anyone unless you give us consent to do so.

How much does your service cost?

Cloud 9 Spine is a free service to patients. We help you find the right treatment with professionals who accept your insurance type. Once you have been matched to a professional, they will bill you as they do all of their patients.

How do I know my doctor is qualified to care for my back problem?

We screen our doctors for active licenses, board certifications, check for legal reviews with their licensing boards and we read their patient feedback and reviews. We also follow up with patients we have helped and make sure they received satisfactory care.

Will I need to obtain any medical records for the doctor?

If you have had any medical services on your neck or back in at least the past 5 years, it will be important to gather those records. MRI’s and x-rays are most helpful but any records will help expedite accurate care.